Protocol-based noninvasive positive pressure ventilation for acute respiratory failure
Protocol-based noninvasive positive pressure ventilation for acute respiratory failure
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DOI：
10.1007/s00540-010-1051-x
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发表时间：
2011-02-01
影响因子：
2.8
通讯作者：
Okamoto, Kazufumi
中科院分区：
文献类型：
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作者：
Kikuchi, Tadashi;Toba, Satoshi;Okamoto, Kazufumi
目的无创正压通气（NPPV）与急性呼吸衰竭（ARF）患者的不良结局有关，可能与气管插管（TI）延迟有关。我们假设，协议为基础的NPPV（pNPPV）可能会改善的结果，与个人医生指导的NPPV（iNPPV）。方法指导决策关于使用NPPV，我们开发了一个NPPV协议。结果pNPPV组（n = 37）和iNPPV组（n = 37）的结果进行了比较。除平均年龄外，两组之间未观察到患者特征的显著基线差异，pNPPV组的平均年龄高于iNPPV组（P = 0.02）。两组的TI率和机械通气时间相似。然而，pNPPV组从NPPV开始到TI的时间往往短于iNPPV组（P = 0.11）。pNPPV组的住院死亡率显著低于iNPPV组（P = 0.049）。虽然pNPPV组的住院时间短于iNPPV组，但这一趋势没有达到统计学意义（P = 0.14）。结论目前的研究表明，pNPPV是有效的，可能会改善急性肾功能衰竭患者的死亡率。
Purpose Noninvasive positive pressure ventilation (NPPV) has been suggested to be associated with adverse outcomes in emergency patients with acute respiratory failure (ARF), possibly because of a delay in tracheal intubation (TI). We hypothesized that protocol-based NPPV (pNPPV) might improve the outcomes, compared with individual physician-directed NPPV (iNPPV).Methods To guide decision making regarding the use of NPPV, we developed an NPPV protocol. Observational data were collected before and after protocol implementation in consecutive patients with ARF and compared between the pNPPV and the iNPPV groups.Results The results for pNPPV (n = 37) were compared with those for iNPPV (n = 37). No significant baseline differences in patient characteristics were observed between the two groups except for mean age, which was higher in the pNPPV group than in the iNPPV group (P = 0.02). Rate of TI and duration of mechanical ventilation were similar in the two groups. However, the time from the start of NPPV until TI tended to be shorter in the pNPPV group than in the iNPPV group (P = 0.11). The hospital mortality rate was significantly lower in the pNPPV group than in the iNPPV group (P = 0.049). Although the length of hospital stay was shorter in the pNPPV group than in the iNPPV group, this trend did not reach statistical significance (P = 0.14).Conclusions The present study suggests that pNPPV is effective and likely to improve the mortality rate of emergency patients with ARF.